Will I regain feeling in my fingertips or toes? Will I walk again? Patients often ask these types of questions about their prognosis and recovery after suffering a traumatic spinal cord injury (SCI). Spine doctors must diagnose SCI quickly before they can begin answering these important questions.
While every patient with SCI is unique and outcomes vary, this article describes many key aspects of traumatic spinal cord injury prognosis and how the first 48 hours after injury are the most critical to your long-term quality of life.
The prognosis for neurological recovery depends mostly on the initial severity of the neurological injury: The more severe the initial nerve damage, the worse the prognosis.
Another factor is where the injury occurred. Generally, nerve injuries in your thoracic spine (mid-back) have a lower chance of recovery than those in your cervical (neck) or lumbar (low back) spine. One reason for this is because nerve damage in your thoracic spine is harder to identify, which underscores the importance of early diagnosis to long-term outcomes.
Most patients who suffer a traumatic SCI experience most of their nerve function recovery during the first 6 months after their injury, though some nerve health can return up to 5 years later.
Predicting Functional Outcomes, Including Ability to Walk
One of the most common questions from patients after SCI is whether they will walk again. Results of the ASIA Impairment Scale (which you can read about in Spinal Cord Injury Classification and Syndromes) hold clues to the answer.
If the ASIA Impairment Scale rates your SCI as a Grade A injury, your chances of walking 1 year after your injury are less than 5%.
People who have an incomplete SCI (where some function and feeling below the injury level is retained) have a much higher chance of walking again compared to those who suffer a complete SCI (a total loss of function and feeling below the injury level).
“Time Is Spine” —The Critical First 48 Hours
Spine doctors who treat SCI understand the meaning of “time is spine.” This phrase refers to the critical first 48 hours after the SCI, which is known as the acute phase of injury. Nerve tissue quickly dies during the acute phase, so promptly diagnosing patients and starting treatment is essential to preserving long-term health and quality of life.
Early Care for Spinal Cord Injury Impacts Prognosis
After a spinal cord injury, emergency services should transport you to the hospital. Waiting for emergency services as opposed to having someone else bring you to the hospital is important, as these professionals are trained how to properly immobilize your neck and back. Your spine may be unstable, so they will position you on a rigid backboard to help protect your spinal column and secure your neck in a cervical brace. These safety precautions can play a significant role in preserving your healthy recovery.
Once you arrive at the hospital, you may be admitted to the intensive care unit (ICU). The ICU staff will closely monitor your heart, blood flow, and respiration. Addressing any potential issues with these systems as soon as they arise may reduce the secondary injury impact of your SCI and improve your recovery (you can read about secondary injuries in Traumatic Spinal Cord Injury's Secondary Injury Cascade).
In addition to monitoring cardiac and lung function, the ICU provides continuous care of traumatic brain, abdominal, thoracic spine, pelvic, fracture, and facial injuries that may accompany your SCI.
Improving Prognosis: Other Spinal Cord Injury Management Techniques
In the first few hours after your SCI, your spine doctor may pay special attention to the blood flow to your spinal cord. This focus on adequate blood flow is called hemodynamics, and it’s very important to preventing any further damage to your spinal cord.
Abnormally low blood pressure, or hypotension, is a common sign of inadequate blood flow, so your medical team will keep a close eye on your blood pressure.
In addition to hemodynamics, you may also receive a high dose of a glucocorticoid called methylprednisolone sodium succinate (MPSS) via intravenous infusion shortly after receiving a SCI diagnosis. The use of this drug may improve your prognosis by helping your nerves recover, but the use of MPSS in the acute phase of SCI is controversial.
The evidence on MPSS for early SCI treatment is mixed. Initial studies showed that MPSS may help protect nerves after spinal cord injury, but later evidence—comparing patients who received a high-dose 24-hour infusion of MPSS to those given a placebo—showed no difference in patient outcomes between the 2 groups. A separate study found that patients who received MPSS within 8 hours of their injury had a 5-point increase in ASIA motor scores at 6-month follow‑up compared with a placebo group.
Possible complications of MPSS include a low risk of gastrointestinal bleeding and wound infection. Your treating spine specialist will decide whether this therapy’s benefits outweigh the drawbacks for you.
Spinal Cord Injury: Prognosis and Moving Forward
Care during the first 48 hours after a spinal cord injury is critical, but it doesn’t end there. Continued medical management also plays a role in your SCI prognosis and long-term outlook. Getting the right care weeks, months, even years after your injury can improve your quality of life and your chances of functional recovery.
Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.